Provider Demographics
NPI:1790325678
Name:ENGLE, TIM (MA)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:ENGLE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 WINTER ST NE APT 606
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3886
Mailing Address - Country:US
Mailing Address - Phone:503-724-8219
Mailing Address - Fax:
Practice Address - Street 1:3085 RIVER RD N
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97303-6512
Practice Address - Country:US
Practice Address - Phone:541-321-2278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2023-07-06
Deactivation Date:2021-02-12
Deactivation Code:
Reactivation Date:2021-03-19
Provider Licenses
StateLicense IDTaxonomies
ORR7590101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health